RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00586
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20040827

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty O3, Contracting Officer, medically separated for “ulcerative colitis” with a disability rating of 10%.

CI CONTENTION:  Medications for the condition are no longer effective, and condition led to procedures.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20040616	VARD - 20040901	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Ulcerative Colitis	7323	10%	Ulcerative Colitis	7323	60%	20040721	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60	

ANALYSIS SUMMARY:

Ulcerative Colitis (UC).  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s UC condition began in February 2004 when he was hospitalized with symptoms of bloating and bloody diarrhea.  He underwent a colonoscopy and was diagnosed with severe ulcerative colitis.  At the time of the initial diagnosis the CI was found to be mildly anemic.  He was started on medications for UC, including oral steroids, with significant improvement.  The NARSUM noted that since he was discharged from the hospital he had “improved tremendously.”

The 25 April 2004 MEB NARSUM examination, 4 months prior to separation, noted complaints of some residual weakness, but reported regular bowel movements occasionally loose, without abdominal pain, bloating, or blood.  He had been returned to duty and was able to do his job.  Physical examination showed minimal tenderness of the left lower abdominal quadrant.  The MEB NARSUM examiner noted the CI was currently doing well on his medication and was successfully performing his duties.  He recommended that the CI be allowed to continue to serve while being followed by a gastroenterologist.  

The 12 May 2004 commander’s statement, 4 months before separation, recommended that the CI be retained, even with restrictions.  The commander noted that the CI’s condition did not affect his ability to perform his normal military duties or restrict him from performing all tasks in a normal duty day, which was often more than eight hours.  The commander indicated that to the best of his knowledge the CI “was not planning on separating.”

At the 21 July 2004 VA Compensation and Pension (C&P) evaluation, 1 months before separation, the CI reported fatigue.  He reported constant abdominal discomfort and loose stools daily, without incontinence or leaking.  He had lost 20 pounds prior to the UC diagnosis and treatment, but had gained all of it back.  His medication at the time of the VA examination was limited to a single anti-inflammatory medication utilized for UC; he was not on oral steroids.  Physical examination showed his abdomen was soft and non-tender.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the ulcerative colitis condition 10%, coded 7323 (colitis, ulcerative).  The VA rated the ulcerative colitis condition 60%, also coded 7323, based on the C&P examination 1 month before separation, citing severe ulcerative colitis.  The PEB assigned a 10% rating and therefore, the panel reviewed to see if a higher rating was supported under 7323.  The evidence supports that following the initiation of appropriate medications, the UC condition was under good control.  There was no evidence of frequent exacerbations for a 30% rating.  The VA rated the UC condition 60%, however, there was no evidence in record of “numerous” exacerbations with only “fair health” during remissions.  Prior to diagnosis and treatment, the CI had lost significant weight and laboratory studies demonstrated mild anemia and impaired absorption.  However, following treatment the commander and the MEB NARSUM examiner both noted the CI was doing well and performing his duties to standard and recommended the CI be retained.  The pre-separation VA examination noted the CI had gained back more than 20 pounds and the abdominal examination was normal, without tenderness.  There was therefore no higher rating available than 10% as adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the ulcerative colitis condition.  

BOARD FINDINGS:  In the matter of the ulcerative colitis condition and IAW VASRD §4.114, the panel unanimously or majority recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD  20762

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2016-00586.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  The Board recommended no re-characterization or modification of your separation.

I carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  I accept their recommendation that your application be denied.

Sincerely,

Attachment:
Record of Proceedings